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When Your Psoriasis Treatment Isn't Working

What to consider if you're not getting the results you wanted.
By Eric Metcalf, MPH
WebMD Feature
Reviewed by Louise Chang, MD

To describe his battle against psoriasis, Alan Eisenberg likes to quote John Paul Jones, the famed Revolutionary War mariner: “I have not yet begun to fight.”

For six years, the Portland, Ore., resident has been trying treatments for his skin condition. Methotrexate helped his nails, but didn’t cure the skin outbreaks. He says the prescription drug Enbrel worked for six months, then lost its effect. Another drug gave him hives. Yet another worked better, but put him at risk of infections. He had to stop using it when he had a hip replaced due to arthritis related to his psoriasis.

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Psoriasis can make you itchy and uncomfortable. Treating it can be annoying and time-consuming. But some of the worst effects of psoriasis are emotional. You may feel like your psoriasis gets in the way of your relationships. It can make people treat you strangely. Depending on where it is on your body, psoriasis can be an embarrassing disease. People around you may not understand your condition and be frightened by it. Even your good friends may refuse your offers to help them out in the kitchen...

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Still, the retired bus driver and union organizer keeps a sense of humor, joking as he reels off the highlights of his fight against the autoimmune disease.

In most cases, doctors can find a treatment that brings this disease under control, several psoriasis experts told WebMD. But the process can take trial, error, and time.

“A huge part of the first visit with patients is breaking the good news and bad news to them. The bad news is they have a chronic disease that is incurable. The good news is there are many treatments available to keep it under control,” says Andrew Blauvelt, MD, of the Oregon Health and Science University in Portland.

“The goal of therapy is to hit on something that works and is safe, and it sometimes takes several tries to find something that works for an individual without side effects,” he says.

Finding the Right Option May Take Some Experimenting

During psoriasis, a person’s immune system acts up, causing skin cells to grow at a faster pace. This causes red patches, which may be rough and scaly. The disease is caused by different genetic glitches in different patients, says Blauvelt, a psoriasis expert who, like the other doctors quoted in this story, has done work on behalf of pharmaceutical companies. Not only does a person’s genetic makeup determine how the disease shows up, it also plays a role in whether treatments will work or not.

“Each person’s response is really individual and different,” says Abby Van Voorhees, MD, of the University of Pennsylvania Health System in Philadelphia. Doctors can offer about a dozen treatments, she says. “I caution my patients that while the first one might not be successful, they really need to hang in there. Most often we can find a modality that will work.”

When deciding which treatment to try first, a doctor will consider how much of your body is affected by outbreaks, says Lawrence Green, MD, a dermatologist in the Washington, D.C. area and a trustee of the National Psoriasis Foundation.

If just a small amount of skin is involved, you may be able to use a topical treatment, such as applying medicine to your skin. If more than 5% of your body is covered with outbreaks, you may need systemic therapy (treatments that go throughout your body, such as pills or injections). (The palm of your hand is the size of about 1% of your body’s surface area, Blauvelt says).

Other signs that suggest you may need a systemic approach include:

  • Having psoriatic arthritis
  • Having outbreaks on more sensitive areas, such as your palms, soles of your feet, face, or genitalia
  • Lack of success with all the topical treatments

You play a role in the success of your treatment. So while you’re seeking a drug that will bring your psoriasis under control, the experts who spoke to WebMD suggested these strategies:

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